Serum Neurofilament Light Levels Help Indicate Multiple Sclerosis Response to Therapy

cerebrospinal fluid csf
cerebrospinal fluid csf
While a useful biomarker, sampling of serum NfL requires multiple lumbar spine punctures.

Serum neurofilament light (NfL) measurements may be useful to help determine the effects of disease-modifying therapies (DMTs) in the management of multiple sclerosis (MS), according to study findings published in Neurology.

Investigators measured paired serum and cerebrospinal fluid (CSF) samples from patients with MS (n=286), subjects with neurologic conditions (n=45), and healthy controls (n=42). The researchers obtained serum and CSF samples prior to and after treatment with DMTs in 138 of the 286 patients with MS.

Compared with healthy controls, patients with relapsing-remitting MS as well as those with progressive MS had significantly higher serum and CSF NfL levels (10.5 ng/L, 16.9 ng/L, and 23 ng/L, respectively; P <.001). The use of DMTs was associated with reductions in serum NfL from 18.6 (interquartile range 12.6-32.7) ng/L to 15.7 (interquartile range 9.6-22.7) ng/L (P <.001).

Initiation of DMT in untreated patients with MS was also associated with a significant decrease in median serum NfL concentrations from 22.7 (17.5-39.1) to 20.2 (13.7-28.9) ng/L (P =.002), as well as a decrease in CSF NfL levels from 907 (564-1608) to 460 (350-675) ng/L (P =.001). Additionally, the investigators found that patients with relapsing MS and those with radiologic activity had greater serum NfL levels compared with those whose disease was in remission (P <.001).

Although this study demonstrates the practical use of CSF NfL measurements as a clinical biomarker in patients with MS receiving DMTs, the investigators suggest that, “the need for lumbar puncture constitutes a major barrier for more widespread use, especially when repeat lumbar punctures are needed.”

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Novakova L, Zetterberg H, Sundström P, et al. Monitoring disease activity in multiple sclerosis using serum neurofilament light protein [published online October 27, 2017]. Neurology. doi:10.1212/WNL.0000000000004683